Acute renal failure in the course of hypercalcemic crisis due to parathyroid carcinoma – the case study

Parathyroid carcinoma is an uncommon cause of PTH-dependent hypercalcemia. The clinical features of parathyroid carcinoma are due primarily to the effects of hypercalcemia due to excessive secretion of PTH. Thus, signs and symptoms of hypercalcemia often dominate the clinical picture. The therapeutic goal at this point is to control the hypercalcemia. A history of the 56-years man admitted to the hospital with acute renal failure in course of the hypercalcemic crisis is described. He was treated with saline hydration and furosemide, with improvement of renal function, however of very little effect on serum calcium levels. Extremely elevated serum PTH-intact of 1789 pg/ml confirmed the diagnosis of primary hyperparathyroidism and a possibility of parathyroid carcinoma had been considered. Since renal failure prevented the use of bisphosphonates, eventually a calcimimetic cinacalcet (Mimpara®), has been used to treat. Satisfactory reduction of serum calcium and PTH enabled to complete the necessery diagnostic procedures and refer the patient for surgery. Histopathological diagnosis of the parathyroid carcinoma had been confirmed. Cinacalcet appears to have been highly effective at controlling acute hypercalcemia in patients with primary hyperparathyroidism.